Healthcare Provider Details

I. General information

NPI: 1023471646
Provider Name (Legal Business Name): SUMMIT BEHAVIORAL HEALTH OF ARIZONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 12/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 E EASTRIDGE RD
PRESCOTT VALLEY AZ
86314-8563
US

IV. Provider business mailing address

637 W HILLSIDE AVE
PRESCOTT AZ
86301-1909
US

V. Phone/Fax

Practice location:
  • Phone: 928-710-7021
  • Fax: 928-708-9620
Mailing address:
  • Phone: 928-710-7021
  • Fax: 928-708-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN T ISENBERG
Title or Position: CEO
Credential:
Phone: 928-710-7021